Genitourin Med: first published as 10.1136/sti.66.1.26 on 1 February 1990. Downloaded from

26 Genitourin Med 1990;66:26-27 Gastrointestinal obstruction associated with Chlamydia trachomatis

DJ Pegg, A WM C Owen

Abstract unfortunately the swabs for chlamydial culture were A patient is reported in whom adhesive inadvertently sent in virus transport medium, cul- obstruction of the small bowel was due to ture was not attempted. However, the swabs from the generalised peritonitis caused by Chlamydia fallopian tubes and cervix were strongly positive for trachomatis. It is concluded that any sexually chlamydia when tested by ELISA (IDEIA Mark 2 active female with unexplained peritonitis or Boots-Celltech and IDEIA Mark 3 (Novo Biolabs adhesive obstruction ofthe small bowel should Ltd). In the absence of Staphylococcus aureus they be screened for chlamydial infection. were regarded as true positives. Samples of blood taken on two separate occasions showed a chlamydial antibody titre of 1/8192 using a single serotype MIF Despite the prevalence ofinfection ofthe genital tract test. Chlamydial IgM antibody was detected in one of and pelvic inflammatory disease caused by these samples at the screening dilution of 1/8. Chlamydia trachomatis, generalised abdominal man- Following surgery the patient was treated with ifestations of chlamydial infection are unusual. doxycycline 100 mg daily for 4 weeks and her symptoms resolved completely. Although her sexual partner was asymptomatic, chlamydia was isolated Case report from his urethra and he was treated with oxytetracy- A female aged 18 years was admitted to hospital on cline 500 mg bd for 2 weeks. three separate occasions in 3 weeks because of repeated attacks of abdominal pain and vomiting. Observation and appropriate investigations excluded Discussion http://sti.bmj.com/ pregnancy, appendicitis and apparently infection of In 1986 there were 157,000 new cases in the UK of the genital tract. During her third admission non-specific infection of the genital tract of which laparotomy was performed for persistent colicky 51,500 occurred in women' and it has been suggested abdominal pain accompanied by clinical and that approximately half of these may be due to radiological signs of gastrointestinal obstruction. Chlamydia trachomatis.2 Despite the prevalence of The peritoneal cavity contained 900 ml of straw

sexually transmitted infection and pelvic inflam- on September 24, 2021 by guest. Protected copyright. coloured fluid and there was a generalised serositis of matory disease caused by chlamydiae, more wide- the infracolic compartment. The liver was normal spread abdominal manifestations are unusual. The and apart from inflammation oftheir covering serosa, best known is the Fitz-Hugh-Curtis syndrome, the appendix, uterus and fallopian tubes appeared peritonitis in the right upper quadrant and peri- normal. There were widespread tenacious adhesions hepatitis associated with infection ofthe genital tract. between adjacent loops of small bowel with adhesive This produces characteristic "violin-string" obstruction of the mid ileum. Peritoneal fluid was adhesions between the capsule of the liver and the submitted for routine bacterial culture whilst swabs adjacent abdominal wall.3 Originally it was thought from the fallopian tubes and cervix were sent for this syndrome was caused by Neisseria gonorrhoeae4 routine culture and the isolation of chlamydia. The but Chlamydia trachomatis has also been implicated.5 obstruction was relieved, appendicectomy was per- Neither perihepatitis, salpingitis or pelvic inflam- formed and the peritoneal cavity was lavaged with a matory disease are invariably present.5 There have solution of tetracycline (1 gm/l). been two reports of generalised peritonitis caused by No pathogens were grown on routine culture and chlamydiae.56 The detection ofchlamydial antigen in the fallopian tubes and the high titres of anti- chlamydial antibody noted in our patient are highly suggestive that the peritonitis was caused by University Department of Surgery, University Hos- pital of South Manchester, Manchester, UK chlamydia.7 DJ Pegg, A W M C Owen We believe this is the first report of adhesive obstruction of the small bowel caused by chlamydial Genitourin Med: first published as 10.1136/sti.66.1.26 on 1 February 1990. Downloaded from

Gastrointestinal obstruction associated with Chlamydia trachomatis 27 peritonitis. It is possible that some previously repor- 1 New cases seen at NHSgenito-urinary medicine clinics 1976-1986. Statistical bulletin. London. Department ofHealth and Social ted cases of so called "primary" peritonitis in young Security 1988. women may have been unrecognised chlamydial 2 Communicable disease surveillance centre. Sexually transmitted diseases surveillance in Britain 1984. Br Med J 1986;293: infection. We recommend that any sexually active 942-3. female with unexplained peritonitis or adhesive 3 Curtis AH. A cause of adhesions in the right upper quadrant. obstruction ofthe small bowel should be screened for JAMA 1930;98:1221-2. 4 Fitz-Hugh T. Acute gonococcal peritonitis in the right upper chlamydial infection. quadrant in women. JAMA 1934;102:2094-6. 5 Muller-Schoop JW, Wang SP, Muzinher J, Schlapfer HU, to Knoblaugh M, Amman RW. Chlamydia trachomatis as possi- We thank Mr E N Gleave for permission publish ble cause of peritonitis and perihepatitis in young women. Br this case and wish to acknowledge the help and Med J 1978;1:1022-4. advice of Dr M E Macaulay and staff of the Central 6 Duffy S, Cawdell G, Fieldman N. Unusual presentation of chlamydial peritonitis: case report. Genitourin Med 1985; Serology Laboratory, University Hospital of South 61:202-3. Manchester. 7 Treharne JD, Ripa KT, Mardh PA, Sevensson L, Westrom L, Darougar S. Antibodies to Chlamydia trachomatis in acute salpingitis. Br J Venereol Dis 1979;55:26-9. Address for reprints: A W M C Owen, Dept of Surgery, University Hospital of South Manchester, Nell Lane, Manchester M20 8LR, UK Accepted for publication 28 September 1989 http://sti.bmj.com/ on September 24, 2021 by guest. Protected copyright.